Facial fractures occurring in a medium-sized metropolitan area: recent trends.

A retrospective 3-year survey of 311 patients sustaining 564 facial fractures in a medium-sized metropolitan area is presented. Etiology, distribution and treatment of these facial fractures are reported and compared with earlier studies, where changing patterns of etiology and treatment were noted. Contemporary knowledge of facial injuries is important if diagnosis and treatment are to be accurate and treatment optimal.

Accidental intra-arterial injection.

The potential for an accidental intra-arterial injection is present whenever an intravenous route of drug administration is used. Because of the serious nature of the morbidity associated with this iatrogenic injury, and its preventability, this article is presented to update the available information on the etiology, diagnosis, treatment, and prevention of this problem.

Temporomandibular joint adaptations following maxillary osteotomy in adolescent monkeys.

The purpose of this study was to investigate the histologic appearance of temporomandibular joints of monkeys who had undergone total maxillary osteotomy. The specific aim of the study was to seek clues that might explain the inhibition in the mandibular growth 27 months following the surgery performed on adolescent monkeys. Eighteen female adolescent Macaca fascicularis monkeys were used. Eight served as control and ten were experimental. All experimental animals underwent 3.0 to 5.0 mm superior and 0.5 to 2.5 mm anterior repositioning of the maxilla. All animals were killed 27 months after the surgical procedure. Qualitative and quantitative histologic evaluations of the temporomandibular joints were done and results were compared with the cephalometric data. The findings showed no pathologic changes, although the histologic appearance of the temporomandibular joints of the experimental animals was more mature than that of the controls. The histologic results support cephalometric findings and the data are discussed in relationship to the role of maxilla, maxillary teeth, and occlusion in regulating mandibular growth.

Changes in bone strength after augmentation with hydroxylapatite or hydroxylapatite/bone.

Adult, male New Zealand white rabbits had one humerus augmented with hydroxylapatite (HA) and one femur augmented with hydroxylapatite and autogenous, cortico-cancellous bone (HA-B). Contralateral bones were not augmented and used for controls. After periods of six and 16 weeks the animals were killed and the load sustained by the test and control bones at fracture was determined using three point loading. A significant increase in the load at fracture was noted in the bones augmented with either HA or HA-B.

Mandibular growth following Le Fort I osteotomy in adolescent monkeys.

Le Fort I osteotomy with anterior and superior repositioning of the maxilla was performed on adolescent Macaca fascicularis monkeys to study its effect on the subsequent growth and remodeling changes of the mandible. Six adolescent Macaca fascicularis monkeys were randomly divided into two surgical groups and eight others served as controls. Group I animals underwent a Le Fort I advancement and Group II animals experienced a Le Fort I advancement and impaction. All monkeys received tantalum implants in the anterior part of the cranial base, on opposite sides of craniofacial sutures and in multiple sites of the maxilla and mandible. The immediate postsurgical occlusion of all experimental animals was a Class II molar relationship. The animals were followed for up to 12 months postoperatively. Analysis of cephalometric head films taken at monthly intervals showed that both the maxilla and the mandible of all experimental monkeys grew in a coordinated fashion, although the amount, rate, and direction of growth varied between control and experimental animals as well as between Group I and Group II animals. The largest increments and rates of growth were observed in the control animals, Group I animals, and Group II animals, respectively. This study indicates that the growth changes in both maxilla and mandible are related to the extent of injury caused by maxillary surgery. The results also showed that although the surgical procedures were performed in the maxilla, mandibular growth was significantly modulated by the surgically changed maxillary environment.

Facial growth subsequent to Le Fort I osteotomies in adolescent monkeys.

The study goal was to assess qualitatively and quantitatively the craniofacial adaptations following total maxillary osteotomy with and without mandibular autorotation. Six adolescent female Macaca fascicularis monkeys were randomly divided into two surgical groups, and eight others served control. Prior to surgery, metallic implants were inserted in the anterior part of the cranial base, on opposite sides of craniofacial sutures, and in multiple sites of the maxilla and mandible. Group I animals underwent a Le Fort I advancement of 4 mm, while Group II animals had a 5-mm advancement and a 2.5-mm impaction. Lateral cephalometric head-films were taken at monthly intervals for a total follow-up of 12 months after surgery. At least two cephalograms were taken on each occasion, one with the teeth in occlusion and the other with the mouth wide open. The latter was used to ascertain accurately the outline of the mandibular condyle. Cephalometric superimposition methods were used to quantify the growth changes. The findings indicated that the growth changes in the maxilla and mandible were related to the extent of injury caused by maxillary surgery. The largest increments and rates of growth were observed respectively in the control animals, Group I animals (anterior maxillary repositioning), and Group II animals (anterior and superior maxillary repositioning). The most interesting finding was that mandibular growth pattern followed maxillary growth pattern in both experimental groups, and the immediate postsurgical occlusion in Class II molar relationship was maintained with increased overjet in both experimental groups throughout the postsurgical observation period.

Effect of maxillary osteotomy on subsequent craniofacial growth in adolescent monkeys.

LeFort I osteotomy was performed on seven adolescent Macaca fascicularis monkeys to study its effect on the subsequent dentocraniofacial growth. Eight adolescent monkeys were used as controls. Tantalum implants were inserted at predetermined areas in certain craniofacial bones of all monkeys. For stereometric cephalometry, implants were placed in both the left and right sides of the facial bones. Lateral cephalometric radiographs of all monkeys were taken prior to and immediately after metallic implant placement, immediately after maxillary osteotomy, and thereafter every 4 weeks during the postsurgical period. At least two cephalograms were taken on each occasion, one with the teeth in occlusion and the other with mouth wide open. The latter was used to view the mandibular condyle adequately. These findings suggest that the maxillary osteotomy did disturb the vertical growth of the maxilla at the PNS and retarded the horizontal growth at the premaxilla. The anterior growth of the maxilla and mandible and the vertical growth of the face were substantially reduced. The most interesting finding was also a reduction of the mandibular growth in all of its dimensions. The rate and the amount of reduced anterior mandibular growth were found to be coordinated with the anterior maxillary growth which resulted in all animals showing a normal overjet, overbite, and occlusion throughout the postsurgical observation period.

Experimental ridge augmentation with porous hydroxyapatite implants.

A new hydroxyapatite ceramic implant material for restoration of atrophic edentulous ridges was tested in a canine animal model. The structure of this material is unique, in that it is produced from the skeleton of a coral, and in that it is penetrated by a uniform network of interconnected pores. Results indicate that bone penetrates its structure to a greater degree than had been observed with similar implants constructed of different materials. Implant insertion through a simple surgical technique involving minimal morbidity is a viable method of placement.

The melanotic neuroectodermal tumor of infancy. Report of two cases and review of the literature.

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare childhood neoplasm with an alarming but classical clinical presentation. It appears as a rapidly enlarging mass in the jaws of skull of infants and unless MNTI is considered in the differential diagnosis, the lesion can easily be mistaken for a malignant neoplasm. Although possessing an aggressive growth rate and radiographic appearance, the MNTI almost always behaves in a benign fashion and can be treated with local excision. However, recent reports of malignant behavior as well as of occasional recurrences make close follow-up important. Approximately 139 cases of the MNTI have been reviewed and tabulated with respect to age at discovery, sex, tumor location, length of follow-up, and whether recurrence occurred, 2 additional cases, 1 of which was in the mandible, are presented along with theories of origin and recommended therapy.

Mucosal grafting over Proplast-augmented edentulous ridges: a pilot study.

Full-thickness mucosal grafts were placed over Proplast-augmented alveolar ridges in six mongrel dogs. Five of the six grafts were successful, indicating that properly prepared recipient sites over Proplast provide adequate blood supply to support free grafts. A thicker keratinizing graft such as palatal mucosa may provide greater protection for the implant under the stress of a prosthesis.

False aneurysm of the facial artery.

A false aneurysm with typical history, clinical and radiographic findings, and histological picture is reported. The absence of enlargement since onset and the absence of bruit were atypical. The latter was probably due to the thick wall of the aneurysm. False aneurysm should be part of the differential diagnosis of swelling of the jaws. Aneurysms should be treated surgically because of the potential for progressive enlargement with danger of spontaneous rupture.

Psychological considerations in corrective maxillary and midfacial surgery.

For the majority of patients with dentofacial deformities, surgical correction results in improved reactions to one's environment. In a few instances, this emotional improvement is lacking or is minimal and may result in a patient's dissatisfaction. The results of evaluation of several specific factors may be used to classify patients into three groups according to probable risk of dissatisfaction. Some negative reactors will respond to supportive measures specifically designed to aid in achieving a smooth postoperative course. In others, surgery should be undertaken only with the close cooperation of a psychiatrist, although occasionally surgery should be deferred indefinitely. By making a planned attempt to evaluate the patient's psychological status and dealing appropriately with that evaluation, the surgeon may increase the number of patients who respond favorably to his treatment and therefore increase his own satisfaction as well.

Rhinocerebral mucormycosis: diagnosis and treatment. Report of two cases.

Rhinocerebral mucormycosis (phycomycetes), a human fungal disease with oral and perioral findings, has an extremely high morbidity and mortality. The disease is most frequently seen in patients with poorly controlled diabetes. The symptoms, findings, and treatment of rhinocerebral mucormycosis are discussed, and two case histories are presented.

Rehabilitation of the atrophic edentulous maxilla by bone grafting.

Transoral bone grafting is a useful method for the reconstruction of the atrophic maxillary residual ridge in patients who cannot retain complete dentures. The indications, criteria for patient selection, and the technique used have been presented.